Everybody is in favour of the nurses. Before, during, and after the nurses’ strike last Wednesday, it was obvious that there was huge public support for their cause. Whether that support is based entirely on emotion or grounded in reason is a moot point.
How could anybody not be in favour of the nurses? The randomness of life, and inevitability of decline and death, means that most of us have needed their help at a vulnerable time.
One always holds a special place in the memory for those who recognise vulnerability and who offer comfort. And that’s completely apart from the professionalism of the nurses.
The doctor or consultant is an occasional figure at the bedside, swooping down to offer expertise and diagnosis.
The nurse is the envoy at ground level, in whom patients and loved-ones confide, who reassures, who is constantly hovering, monitoring, recording results, and generally providing an air of control and care.
Understandably, most people would be sympathetic to nurses who feel undervalued and underpaid. (From my own experience, the healthcare workers who are really undervalued are care assistants. Their work is primal, requiring literally hands-on care and empathy, which can’t be faked. Their pay is simply not commensurate with the work they do.)
The respect and affection for nurses ensures that when they go on strike for better pay, the public flocks to their standard en masse.
So do the politicians, who have a keen sense of the votes to be harvested in a cost-free, extremely popular cause. In that regard, some of the robust advocacy for the nurses this week was difficult to stomach. On every occasion and forum on which the matter was debated, there was a loud and mad rush by opposition politicians to the side of the angels.
This was particularly galling coming from Fianna Fáil and, to a lesser extent, Sinn Féin, Labour, and the Social Democrats, simply because these parties have real aspirations to govern.
Does anybody believe for a second that Fianna Fáil would handle this issue any differently to the current government? Ditto for the smaller parties, with allowance for a few tweaks here and there.
In any event, it all adds up to a serious emotional punch when nurses strike. They also have some reason on their side.
Nurses can cogently argue that they operate at the very heart of what is, in places, a completely disorganised health service. A case could be made that because they bear the greatest brunt of political and administrative mismanagement, their remuneration deserves to be enhanced.
They might also point to the news this week of the debacle of waste that is the national children’s hospital project and ask why the billions weren’t better directed at improving pay and conditions in a stressful working environment.
Another plank of their case is that they want and deserve to be on a pay scale equivalent to other professional health workers, such as physiotherapists and radiographers. This is a reasonable claim and might be explored in the context of whether some within the service, such as consultants, are overpaid.
Beyond those points, though, reason does not appear to be a friend to the nurses’ case.
Timing is the first problem. With Brexit looming, who knows which way the economic wind will blow. The Government is being asked to stump up at least €300m for a 12% hike in nurses’ pay. The cost usually increases, sometimes exponentially, after the award is made. Would it be responsible to respond positively to the pay demand?
Some predictions suggest that if Brexit goes pear-shaped, up to 55,000 jobs could be lost in the private sector in the short-term. With dark clouds looming, is there a case for any element of the public service receiving an unscheduled hike in pay right now?
There is also no getting away from the domino effect. Inevitably, any pay rise would trigger an avalanche of claims from elsewhere in the public service. Some of these would be undeserving, but others might have an even stronger case than nurses for an unscheduled rise.
The point is that unless some mechanism is found to isolate the nurses’ claim, the cost would be unsustainable in the current environment.
The biggest obstacle of reason to the nurses’ current pay claim is the premise on which it is advanced. The Irish Nurses’ and Midwifes’ Organisation claim that this is about recruitment and retention. This implies that, if nurses are given a 12% rise, many who are working abroad will be tempted home.
Is this a reasonable argument? The Public Service Pay Commission, which examined recruitment and retention in the system, was published last September. The commission found, among other things, that the only issue in this regard was in some specialised areas. It also found that:
Remuneration wasn’t the main obstacle in those specialised areas experiencing a shortage of qualified personnel;
There were 5,494 first-preference applications for 1,830 nursing and midwifery undergraduate places in 2018; The average earnings for all HSE staff nurses and midwifes (excluding all promotional grades) in 2017 were approximately €51,000, including allowances and overtime payments.
All these points undermine the basis for the current strike, but the INMO doesn’t accept the report. Should there be another examination of the issue? What if the result was the same? Would it still be wrong? Can any group that has excellent lobbying skills and public support simply smother unpalatable facts?
This gives rise to the overarching question about the premise for the strike.
Would one nurse be swayed to return home to the Irish health service if the 12% rise was granted? The public pay commission report says no. The INMO suggests they’d be flocking home by the new time.
Much of this stuff gets lost in the emotion, and understandably so. We live in a time when emotion often trumps reason. This is a growing feature of politics. The brand of populism retailed by the likes of the hard
Brexiteers or Donald Trump operates on the basis that facts are irrelevant to their emotional pitch. Elements of the media, likewise, have recognised that appealing to emotion should be the driving force of the news they produce.
In the case of the nurses, the emotion generated by their cause, and their decision to strike, is genuine and grounded in lived experience.
The balance of reason, in this particular campaign, however, is not in their favour. But in today’s world, it’s not really clear how much that matters. The next few weeks, during which more strikes are scheduled to take place, will tell a lot.